Category Archives: Principles of Complicated Exodontia

Immediate Treatment
The best treatment of a potential sinus exposure is avoiding the problem through careful observation and treatment planning. Evaluation of high-quality radiographs before surgery begins usually reveals “the presence .or , absence of an excessively pneumatized sinus or widely . divergent or dilacerated roots, which have the potential of having a communication with the sinus or causing

Extraction Sequencing
The order in which multiple teeth are extracted deserves some discussion. Maxillary teeth should usually be re
FIG. 8-50 A, Open-window approach for retrieving root is indicated when buccocrestal bone mustbe maintained. Three-cornered flap is reflected to expose area overl_g apex of root fragment beingrecovered. 8, Bur is used to u~cover apex of root and allow sufficient access for insertion

Policy for Leaving Root Fragments
When a root tip has fractured, when closed approaches of. .removal have been unsuccessful, and when. the open approach may be excessively traumatic, the surgeon may consider leaving the root in place. As with any surgical approach, the surgeon must balance the benefits of surgery against the risks of surgery. In some situations the risks of removing a small root tip may outwe

Removal of Small Root Fragments and Root Tips
If fracture of the apical one third (3 to 4 111m)of till’ root occurs during a closed extraction, an orderly procedure should be used to remove the root tip from the socket. Initial attempts should be made to extract the root fragment by a closed technique, but the surgeon should
FIG. 8-43 A,
FIG. 8-45 A,
begin a surgical technique if the closed technique is n

Technique for Surgical Removal of Multirooted Teeth
If the decision is made to perform an open extraction of a multi rooted tooth, such as a mandibular or maxilIary molar, the same surgical, technique used for the single rooted tooth is generally used. The major difference is that the tooth may be divided with a bur to convert a multi rooted tooth into several single-rooted teeth. If the crown of the tooth re

Technique for Open Extraction of Single Rooted Tooth
The technique for open extraction of a single rooted tooth is relatively straightforward but requires attention to detail, because several decisions must be made during . the operation. Single-rooted teeth are those that have resisted attempts at closed extraction or that have fractured at the cervical line and therefore exist only as a root. The technique

Indications for Surgical Extraction
It is prudent for the surgeon to evaluate carefully each patient and each tooth to be removed for the possibility of an open extraction. Although the vast majority of decisions will be to perform a closed extraction, the surgeon must be aware continually that open extraction may be the less morbid of the two.
As a general guideline surgeons should consider performing an elec

PRINCIPLES AND TECHNIQUES
FOR SURGICAL EXTRACTION
Surgical extraction of an erupted tooth is a technique that should not be reserved for the extreme situation. Aprudently used open Extraction technique may be more conservative and cause less operative morbidity than a closed extraction. Forceps extraction techniques that require great force may result not only in removal of the tooth but also of large amounts

Principles of Suturing
Once the surgical procedure is completed and the wound properly irrigated and debrided, the surgeon must return the flap to its original position or, if necessary, arrange it in a new position the flap should be held in place with sutures. Sutures perform multiple functions. The most . obvious and important function that sutures perform is to coapt wound margins that is, to hold the fla